[Incidence of lower extremity amputations in Area 3 of Madrid. Retrospective study during the period 2001-2006]. / Incidencia de amputaciones de extremidades inferiores en el área 3 de Madrid. Estudio retrospectivo del periodo 2001-2006.

OBJECTIVE: To quantify the Lower Extremity Amputations (LEA) incidence in population with and without diabetes mellitus (DM). MATERIAL AND METHODS: Retrospective cohort study of all the LEA carried out during 2001-2006 in area 3 of Madrid, from the codification of the reports of discharge reports. RESULTS: 310 LEA were carried out. The age-ajusted LEA incidence for any reason was 19,2/10(5) inhabitants per year (27,2 y 11,2 for men and women respectively). 261 were not-traumatic and non-tumoural (NTT) LEA, 76% were associated with DM and the incidence was 191/10(5) people with DM per year (95% confidence interval [CI(95)] 122-299) and 4,4/10(5) for people without DM per year (CI(95) 7-23), with a risk ratio of 44 (CI(95) 23-73). CONCLUSIONS: The LEA rates in population with o without diabetes are higher than the previously communicated in Madrid. It would appear convenient to design strategies to reduce the LEA rates.

Incidencia de amputaciones de extremidades inferiores en el área 3 de Madrid. Estudio retrospectivo del periodo 2001–2006 / Incidence of lower extremity amputations in Area 3 of Madrid. Retrospective study during the period 2001–2006

Objetivo Conocer la incidencia de las amputaciones de miembro inferior (AMI) en población con y sin diabetes mellitus (DM). Material y métodos Estudio retrospectivo de cohortes de las AMI realizadas durante 2001–2006 en el área 3 de Madrid a partir de la codificación de los informes de alta hospitalaria. Resultados Se realizaron 310 AMI. La incidencia ajustada a la edad de AMI de cualquier causa fue de 19,2/105 habitantes/año (27,2 y 11,2 para varones y mujeres, respectivamente). Doscientos sesenta y uno fueron AMI no traumáticas ni tumorales, el 76% se realizaron en DM y la incidencia fue de 191/105 sujetos con DM por año (intervalo de confianza del 95% [IC95] 122–299) y de 4,4/105 sujetos sin DM (IC95 7–23) con un riesgo relativo (RR) de 44 (IC, 23–73). Conclusiones La tasa detectada de AMI en población con y sin diabetes es mayor que la comunicada previamente en Madrid. Se plantea la necesidad de diseñar estrategias para reducir las tasas de AMI(AU)

Objective To quantify the Lower Extremity Amputations (LEA) incidence in population with and without diabetes mellitus (DM). Material and methods Retrospective cohort study of all the LEA carried out during 2001–2006 in area 3 of Madrid, from the codification of the reports of discharge reports. Results 310 LEA were carried out. The age-ajusted LEA incidence for any reason was 19,2/105 inhabitants per year (27,2 y 11,2 for men and women respectively). 261 were not-traumatic and non-tumoural (NTT) LEA, 76% were associated with DM and the incidence was 191/105 people with DM per year (95% confidence interval [CI95] 122–299) and 4,4/105 for people without DM per year (CI95 7–23), with a risk ratio of 44 (CI95 23–73). Conclusions The LEA rates in population with o without diabetes are higher than the previously communicated in Madrid. It would appear convenient to design strategies to reduce the LEA rates(AU)

[Management in clinical nutrition]. / Gestión en nutrición clínica.

Terms such as management, costs, efficacy, efficiency, etc. that are so common in the discourse of managers are now beginning to appear in the vocabulary of clinicians. Management in Clinical Nutrition is an innovative aspect of interest among health-care professionals dealing with the needs of undernourished patients or those at risk of malnutrition. The basic goal of this paper is to show that the tools for clinical management of hospitals are applicable to such a multidisciplinary and complex speciality as clinical nutrition and also to propose the measures needed to improve our information systems and optimize management in this field. The very concept of hospitals has changed, as has their activity, over the years. Hospitals are nowadays no longer just a charitable institution but has become a service company, a public utility for the promotion of good health and they have to be managed in accordance with criteria of efficacy, efficiency, equity and quality. The concepts of Evidence-Based Medicine (EBM) and Cost-Effective Medicine (CEM) are of evident importance in the different ways of managing health-care services. Good clinical practice is the combination of EBM and CEM. This review defines the various cost studies of fundamental importance when taking decisions in hospital management and analyzes such clinical management tools as analytical accounting, Minimum Hospital Database Set (MHDS) and encoding systems, among others, thus facilitating an analysis of the usefulness of data in clinical nutrition management systems. Finally, after reviewing some specific examples, measures are proposed to optimize current information systems. The medical staff and those of us responsible for Nutrition Units operate in hospitals as part of a centralized service transferring information to the various departments where the patient is physically located (Surgery, Internal Medicine, Digestive, ICU, etc.). One of the priority goals in micro-management and middle management is to observe the quality improvement in the discharge reports for the patients admitted, including the nutritional diagnosis within the section for the main diagnosis, and also the administration of artificial nutrition (enteral or parenteral) in the section on procedures. With all of these measures we will improve the quality of the hospitals' information systems and contribute directly to ensuring that our activities in clinical nutrition have an impact on the overall results of the hospital when measured in terms of effectiveness, efficacy or quality.

Gestión en nutrición clínica / Management in clinical nutrition

Términos como gestión, costes, eficacia, eficiencia, etcétera, habituales en el discurso de los gestores, comienzan a ser integrados en el lenguaje de los clínicos. La Gestión en Nutrición Clínica es un aspecto novedoso y de interés entre los profesionales sanitarios que atienden las necesidades de los pacientes desnutridos o en riesgo de desnutrición. El objetivo fundamental de este trabajo es demostrar como las herramientas de gestión clínica hospitalaria, son aplicables a una disciplina tan multidisciplinar y compleja como la nutrición clínica y proponer las medidas necesarias para mejorar nuestros sistemas de información y optimizar la gestión en ese campo. El concepto de hospital ha ido cambiando, así como su actividad, a lo largo de los años. En la actualidad el hospital ya no es un centro de caridad sino que se ha convertido en una empresa de servicios, una empresa de utilidad pública para la promoción de la salud que debe ser gestionada con criterios de eficacia, eficiencia, equidad y calidad. Los conceptos de MBE (Medicina Basada en la Evidencia) y la MCE (Medicina Coste Efectiva) tienen un importante peso en las diferentes formas de hacer gestión sanitaria. La buena práctica clínica es aquella que combina la MBE con la MCE. En esta revisión se definen los diferentes estudios de costes, fundamentales en la toma de decisiones en la gestión sanitaria, y se analizan las herramientas de gestión clínica como la contabilidad analítica, el CMBDH (Conjunto Mínimo de Base de Datos Hospitalaria) y los sistemas de codificación entre otros, facilitando así el análisis de la utilidad de la información en los sistemas de gestión en nutrición clínica. Por último tras revisar algunos ejemplos concretos se proponen medidas para optimizar los actuales sistemas de información. Los facultativos y responsables de las Unidades de Nutrición funcionamos en los centros hospitalarios como parte de un servicio centralizado que traslada la información a los servicios finales en los que se encuentra físicamente localizado el paciente (Servicio de Cirugía, Medicina Interna, Digestivo, UCI, etc.). Un objetivo prioritario en la micro y mesogestión observará la mejora en la calidad de los informes de alta de los pacientes ingresados, incluyendo el diagnóstico de desnutrición dentro del apartado de diagnóstico principal, y la administración de nutrición artificial (enteral o parenteral) en el apartado de procedimientos. Con todo ello mejoraremos la calidad de los sistemas de información hospitalaria y contribuiremos de manera directa a que la actividad desarrollada desde el ámbito de la nutrición clínica repercuta en los resultados hospitalarios globales cuando estos se midan en términos de efectividad, eficacia o calidad (AU)

Terms such as management, costs, efficacy, efficiency, etc. that are so common in the discourse of managers are now beginning to appear in the vocabulary of clinicians. Management in Clinical Nutrition is an innovative aspect of interest among health-care professionals dealing with the needs of undernourished patients or those at risk of malnutrition. The basic goal of this paper is to show that the tools for clinical management of hospitals are applicable to such a multidisciplinary and complex speciality as clinical nutrition and also to propose the measures needed to improve our information systems and optimize management in this field. The very concept of hospitals has changed, as has their activity, over the years. Hospitals are nowadays no longer just a charitable institution but has become a service company, a public utility for the promotion of good health and they have to be managed in accordance with criteria of efficacy, efficiency, equity and quality. The concepts of Evidence-Based Medicine (EBM) and Cost-Effective Medicine (CEM) are of evident importance in the different ways of managing health-care services. Good clinical practice is the combination of EBM and CEM. This review defines the various cost studies of fundamental importance when taking decisions in hospital management and analyzes such clinical management tools as analytical accounting, Minimum Hospital Database Set (MHDS) and encoding systems, among others, thus facilitating an analysis of the usefulness of data in clinical nutrition management systems. Finally, after reviewing some specific examples, measures are proposed to optimize current information systems. The medical staff and those of us responsible for Nutrition Units operate in hospitals as part of a centralized service transferring information to the various departments where the patient is physically located (Surgery, Internal Medicine, Digestive, ICU, etc.). One of the priority goals in micro-management and middle management is to observe the quality improvement in the discharge reports for the patients admitted, including the nutritional diagnosis within the section for the main diagnosis, and also the administration of artificial nutrition (enteral or parenteral) in the section on procedures. With all of these measures we will improve the quality of the hospitals´ information systems and contribute directly to ensuring that our activities in clinical nutrition have an impact on the overall results of the hospital when measured in terms of effectiveness, efficacy or quality (AU)